沿海地区耐碳青霉烯类铜绿假单胞菌耐药基因分析和同源性研究
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摘要
目的了解本地区临床分离耐碳青霉烯类铜绿假单胞菌IMPRPAE耐药基因和同源性,为临床治疗和流行病学调查提供理论依据。方法从台州恩泽医院收集IMPRPAE 60株,用VITEK 2 Compact仪器进行鉴定和药敏试验;采用PCR的方法检测耐药基因;采用脉冲场凝胶电泳(PFGE)进行同源性检测。结果 IMPRPAE对阿米卡星和庆大霉素的敏感率分别为68. 3%、60. 0%,对其他抗生素的敏感率均<50%。携带IMP基因10株,阳性率为16. 7%,携带VIM基因4株,阳性率为6. 8%,其他产酶基因未检出; Opr D2基因缺失31株,占51. 7%。经PFGE分析为A型、B型、C型、D型、E型、F6型,A型24株,B型14株、C型9株、D型6株、E型4株、F型3株。结论该院IMPRPAE的耐药严重,其耐药机制主要与产生VIM和IMP 2种基因型的碳青霉烯酶及膜孔蛋白Opr D2基因缺失有关; A型基因型引起医院克隆菌株的流行播散。
Objective To analyze the resistant gene and the homology of carbapenems resistant Pseudomonas aeruginosa in Taizhou,so as to provide basis for clinical anti-infection treatment and epidemiological investigation. Methods Sixty strains of carbapenems resistant Pseudomonas aeruginosa( IMPRPAE) were collected from Taizhou Enze Hospital,and VITEK-2Compact was used to identify the isolated strains and test their drug sensitivities; resistant genes were detected by PCR. The homologies of the 60 isolated strains were analyzed by pulse field gel electrophoresis( PFGE). Results The resistant rates of the 60 IMPRPAE strains to amikacin and gentamicin were 68. 3% and 60. 0%,respectively. These Pseudomonas aeruginosa isolates showed drug resistance under 50% to other antibiotics. The positive rates of VIM and IMP were 6. 8%( 4 strains),16. 7%( 10 strains),and other genes producing enzyme were not found. The absent rate of Opr D2 was 51. 7%( 31 strains).According to PFGE analysis,the isolates were divided into A type( 24 strains),B type( 14 strains),C type( 9 strains),D type( 6 strains),E type( 4 strains),F6 type( 3 strains). Conclusion The antimicrobial resistance of IMPRPAE is very serious in the hospital,and the drug resistance mechanism is mainly related to the carbapenemase producing VIM and IMP and the deletion of membrane pore protein Opr D2 gene. Type A genotypes caused widespread of cloned strains in hospital.
Objective To analyze the resistant gene and the homology of carbapenems resistant Pseudomonas aeruginosa in Taizhou,so as to provide basis for clinical anti-infection treatment and epidemiological investigation. Methods Sixty strains of carbapenems resistant Pseudomonas aeruginosa( IMPRPAE) were collected from Taizhou Enze Hospital,and VITEK-2Compact was used to identify the isolated strains and test their drug sensitivities; resistant genes were detected by PCR. The homologies of the 60 isolated strains were analyzed by pulse field gel electrophoresis( PFGE). Results The resistant rates of the 60 IMPRPAE strains to amikacin and gentamicin were 68. 3% and 60. 0%,respectively. These Pseudomonas aeruginosa isolates showed drug resistance under 50% to other antibiotics. The positive rates of VIM and IMP were 6. 8%( 4 strains),16. 7%( 10 strains),and other genes producing enzyme were not found. The absent rate of Opr D2 was 51. 7%( 31 strains).According to PFGE analysis,the isolates were divided into A type( 24 strains),B type( 14 strains),C type( 9 strains),D type( 6 strains),E type( 4 strains),F6 type( 3 strains). Conclusion The antimicrobial resistance of IMPRPAE is very serious in the hospital,and the drug resistance mechanism is mainly related to the carbapenemase producing VIM and IMP and the deletion of membrane pore protein Opr D2 gene. Type A genotypes caused widespread of cloned strains in hospital.
引文
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[8]石庆新,叶黎红,许成新.重症监护室耐碳青霉烯类铜绿假单胞菌相关耐药基因的研究[J].中国现代医生,2012,50(7):30-32.
[9]张妍,张立.铜绿假单胞菌对碳青霉烯类抗菌药的耐药机制研究进展[J].国际检验医学杂志,2015,36(17):2548-2549.
[10] Queenan AM,Bush K. Carbapenmases the versatlie beta-lactamase[J]. Clin Microbiol REV,2007,20(3):440-458.
[11]闫玉兰,郭世辉,李萌,等.耐亚胺培南铜绿假单胞菌的耐药机制研究[J].中华医院感染学杂志,2014,40(15):3650-3652.
[12]李永丽,应春妹.耐碳青霉烯类鲍曼不动杆菌分子流行病学及耐药机制研究[J].上海交通大学学报:医学版,2012,32(11):1430-1435.
[13]李娟娟,夏国莲,左阿芳,等. ICU耐美罗培南铜绿假单胞菌感染的治疗分析[J].中华医院感染学杂志,2016,26(9):2038-2040.
[14]冯靖雄,黄纯友,兰清,等.重症监护病房耐美罗培南铜绿假单胞菌感染的危险因素分析及干预对策[J].解放军医药杂志,2017,29(10):87-89.
[15]张琼,曾莉,毛方菊,等.重症监护病房鲍氏不动杆菌致呼吸机相关性肺炎的危险因素分析及干预对策[J].中华医院感染学杂志,2017,27(3):554-557.
[16]王娜,贾俐萍,王莉,等.医院耐碳青霉烯类铜绿假单胞菌的流行及相关因素分析[J].中国医院药学杂志,2016,36(2):138-141.
[17]黄秋兰,封卫征,范德平,等.多药耐药铜绿假单胞菌感染危险因素的荟萃分析[J].中华医院感染学杂志,2016,26(5):970-972.
[2]胡付品,郭燕,朱德妹,等. 2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-482.
[3]刘洋,邓琼,余阳,等.碳青霉烯类抗生素耐药铜绿假单胞菌的耐药机制及同源性分析[J].中华烧伤杂志,2014,30(1):15-20.
[4]丁士标,陈爱凤,潘亚萍,等.耐亚胺培南铜绿假单胞菌耐药特征和碳青霉烯酶基因分析[J].中国卫生检验杂志,2017,27(11):1636-1637.
[5]杨丽君,陈坚,杨燕,等.碳青霉烯类耐药肺炎克雷伯菌基因型检测和同源性分析[J].中华检验医学杂志,2013,36(4):1-6.
[6] Tenover FC,Arbeit RD,Coering RV,et al. Interpreting chromosomal DNA restriction pettems produced by pulsed-field gel electrophoresis:criteria for bacterial strain typing[J]. J Clin Microbiol,1995,33(9):2233-2239.
[7] Cavalcanti FL,Almeida AC,Vilela MA,et al. Changing the epidemiology of carbapenem-resistant Pseudomonas aeruginosa in Brazilian teaching hospital:the replacement of so paulo metal-lo-β-lactamase-producing isolates[J]. Mem inst Oswaldo Cruz,2012,107(3):420.
[8]石庆新,叶黎红,许成新.重症监护室耐碳青霉烯类铜绿假单胞菌相关耐药基因的研究[J].中国现代医生,2012,50(7):30-32.
[9]张妍,张立.铜绿假单胞菌对碳青霉烯类抗菌药的耐药机制研究进展[J].国际检验医学杂志,2015,36(17):2548-2549.
[10] Queenan AM,Bush K. Carbapenmases the versatlie beta-lactamase[J]. Clin Microbiol REV,2007,20(3):440-458.
[11]闫玉兰,郭世辉,李萌,等.耐亚胺培南铜绿假单胞菌的耐药机制研究[J].中华医院感染学杂志,2014,40(15):3650-3652.
[12]李永丽,应春妹.耐碳青霉烯类鲍曼不动杆菌分子流行病学及耐药机制研究[J].上海交通大学学报:医学版,2012,32(11):1430-1435.
[13]李娟娟,夏国莲,左阿芳,等. ICU耐美罗培南铜绿假单胞菌感染的治疗分析[J].中华医院感染学杂志,2016,26(9):2038-2040.
[14]冯靖雄,黄纯友,兰清,等.重症监护病房耐美罗培南铜绿假单胞菌感染的危险因素分析及干预对策[J].解放军医药杂志,2017,29(10):87-89.
[15]张琼,曾莉,毛方菊,等.重症监护病房鲍氏不动杆菌致呼吸机相关性肺炎的危险因素分析及干预对策[J].中华医院感染学杂志,2017,27(3):554-557.
[16]王娜,贾俐萍,王莉,等.医院耐碳青霉烯类铜绿假单胞菌的流行及相关因素分析[J].中国医院药学杂志,2016,36(2):138-141.
[17]黄秋兰,封卫征,范德平,等.多药耐药铜绿假单胞菌感染危险因素的荟萃分析[J].中华医院感染学杂志,2016,26(5):970-972.